Individual
DR. DOUGLAS GAVIN KONDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
501 S CHIPETA WAY, SALT LAKE CITY, UT 84108-1222
(801) 585-1575
Mailing address
PO BOX 413076, SALT LAKE CITY, UT 84141-3076
(801) 213-3900
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
6313601-1205
UT
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
6313601-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11725447
CAQH NUMBER
UT
01
—
6313601-1205
UTAH MEDICAL LICENSE
UT
Enumeration date
10/12/2006
Last updated
03/07/2023
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us